Gemcitabine-Induced Pseudocellulitis in a Patient With Recurrent Lymphedema

Abstract

Gemcitabine is a chemotherapeutic agent used for treatment of a variety of malignancies. It has been associated with multiple cutaneous reactions including rash, alopecia, and pruritus. Less commonly, gemcitabine has been associated with "pseudocellulitis," a noninfectious skin inflammatory reaction, which resembles cellulitis. The majority of cases reported in the literature are radiation recall reactions in which inflammation occurs in areas of previous radiation post drug treatment; however, there are also reports of pseudocellulitis occurring in areas of preexisting lymphedema. The pathophysiology of both of these reactions are still unknown, though it is theorized that areas of lymphedema may both increase concentration of gemcitabine and reduce its rate of metabolism leading to increased drug exposure time. In this study, we report a case of pseudocellulitis in a patient with chronic lower extremity lymphedema and a review of the current literature. By recognizing this side effect of gemcitabine, one can avoid unnecessary hospitalization and exposure to antibiotics.

Gemcitabine-associated acute lipodermatosclerosislike eruption: An underrecognized phenomenon

“…1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 Radiation recall events were excluded, as we believe they represent a separate category of cutaneous reactions and can be distinguished based on clinical history and physical findings.…”

Gemcitabine-induced pseudocellulitis in a patient with non–small cell lung carcinoma

“…The pathophysiology of this reaction is still unknown, although it is theorized that areas of impaired lymphatic drainage lead to drug permeation into interstitial fluid, drug accumulating in the subcutaneous tissue, and inadequate drug inactivation in subcutaneous tissue. 2 , 4 …”

“…The duration of gemcitabine-induced pseudocellulitis is proposed to be related to the drug's pharmacokinetics and may exist until the drug is displaced from the subcutaneous tissue of the affected area. 2 Nonsteroidal anti-inflammatory drugs, diphenhydramine, and topical steroids may be given for symptomatic therapy. 1 , 4 , 9 …”

“…Gemcitabine is also associated with cutaneous adverse effects such as rash, alopecia, pruritus, radiation recall dermatitis, hypersensitivity reactions, hyperpigmentation, and erysipeloid reactions. 1 , 2 , 3 There are also a few isolated cases of livedo reticularis, sclerodermalike changes, Sweet's syndrome, and toxic epidermal necrolysis. 3 …”

Gemcitabine associated pseudocellulitis: A missed diagnosis

“…Though, with increasing use, reports of a pseudo-cellulitis dermatologic reactions are being reported. [1][2][3][4][5][6][7][8][9][10][11][12] Here we report a patient case of a 51-year-old male who has received multiple cycles of gemcitabine over the course of 3 years, who presents to our ED with redness of the bilateral extremities deemed to be associated with gemcitabine exposure.…”